Wednesday, June 2, 2010

You've seen them. They're in newspapers and regional magazines across the country. Some smiling mom and her cute kid. It's an ad for some local clinic, always with a tagline like "You can't afford to be sick!" or "You don't have time to be sick!".

And they list things they treat, like headache, sore throat, ankle sprain, runny nose, and skinned knee (who the hell goes to the doctor for a skinned knee?). They make no mention of heart attack. Or accidental amputation. Or arrow through the head.

It's so comically misleading. As if there's something abnormal about being sick. Face it. The germs outnumber us. Being sick is part of the price of doing business of Earth. We all catch the crud here and there. And we all trip and fall, spraining this and scraping that.

These ads give the impression that it's horribly abnormal to catch some mild illness or suffer a minor injury. Better yet, they make it sound like they can magically fix you, like they're going to wave a wand, and the germs will suddenly vanish or you'll grow new skin immediately.

All they do is give you Sudafed and/or Tylenol and/or a band-aid, (which you could have bought yourself) and bill your insurance.

What really peeves me is that this enforces a cultural dependency on medical care. Yes, I'm a doctor. Medical care is how I earn a living. And there are certainly MANY conditions where you absolutely, positively, should see a medical professional. And I know sometimes it's hard to know what's what.

But did your Mom send you to the doctor for every little thing? (I know, some Moms did) Probably not. She sent you to bed, gave you some Tylenol, and told the school you were out. Or she gave you Tylenol and sent you to school.

And I'm willing to bet you felt a hell of a lot sicker at some point in college, after toga night at McBarfy's house of cheap beer. And you didn't see a doctor for that, either.

We have a lot of treatments in medicine. But the majority of things you get in your everyday life will get better with or without a doctor.

"The art of medicine consists of amusing the patient while nature cures the disease."

Voltaire wrote that around 250 years ago. And, for the most part, I won't argue with him.

49 comments:

What drives me bonkers is the list of ailments kids get sent home from school with. My mom only kept me home from school when I a) had a fever over 100, or b) was vomiting. Today they get sent home for a cough, runny nose, a little diarrhea, pink eye. When I did my peds rotation, 1/2 the visits were from kids who'd been sent home. Apparently, the school or daycare *required* a note from the doctor for the child to return. And this was for the conditions I mentioned above.

As a side note, a real gem I used to work with (who is now a psychologist -- go figure) complained loudly and often (but never directly to me, only when I was within earshot) when I came to work with a cough after I'd been out sick for a day or two. She was concerned I'd infect the rest of the office. With what, I do not know. Post infectious bronchospasm is not contagious as far as I've heard.

I put off going to the doctor. Sorry, but I hate doctors. Well, ok, maybe I don't hate doctors...I'm sure I'd be perfectly happy having a cookout in the backyard with you and your family. I, however, would avoid going to see you professionally at all costs. I go in once a year to have blood work done so I can get my years supply of Synthroid, and that's about it. Oh, and the dentist I go to twice a year, and the eye doctor once a year, and that is it. I really try to not go unless I absolutely have to, the rest of the year.

My son is the same way. He hates going. I never was one of those parents who rushed my child to the doctor every time he sneezed, but I will admit, I have taken him in a bit more this year than I ever had before. I think I brought him to the doctor 2 times this year. Why did I bring him in? Because last year he almost died from bacterial meningitis, and now I'm not taking any chances. Still, though, I only brought him in twice (and one of those times he had bronchitis, so I am glad I brought him in that time...the other time he was constipated, should have just given him prunes!), and people think I'm nuts because I don't rush him to the doctor every time he sneezes. Most of the people I know bring their kids (and themselves!) to the doctor for no reason at all, if you ask me. I don't understand. I mean, geeez, I swear I had the 'swine flu' a year ago...I had all the symptoms, every single one of them, but I'll never know for sure because I didn't bother to go to the doctor to be checked out. I stayed home and away from people so I wouldn't spread whatever it was I had. and my son is perfectly healthy, that meningitis was a fluke, chances of it happening again are small...there is no need to run to the doctor for every sneeze.

While we bemoan the crazees and those who abuse the hell out of the Emergency Department for "vomicking" and runny noses, Dr. G is correct that there are many OTHERS who see illness as a personal moral failing.

We have all met this woman (and it is almost always a person of the double "X" persuasion)....She jogs, takes her homeopathic treatments, squeezes her own juices, and hasn't touched red meat since her junior year of college.

No problem and good for her, right? Well, yeah, except she has NEVER been sick a day in her adult life, all due to her wonderful self-care and iron-clad will which allows her to REFUSE to be ill or injured.

AND, if YOU have been sick, well *tsk-tsk* you just haven't been trying very hard, have you??? Genetics, exposure to occupational hazards, choosing the wrong seat on an international flight, drunks running red lights...excuses, excuses, excuses! Try some blue-green algae and stop whining. Malaria and ovarian cancers go away eventually...

My family has always been weird about stuff like that, though. A few years back my father had cancer. In the middle of his radiation treatment, he decided to take a week off and drive to my house (700 miles away) for a visit. And when my son was born, I had an emergency c-section. That would knock most people out, right? Not me. I hated being in the hospital, so 2 days, yes, just 2 days after my son was born, I checked both of us out of the hospital, went home, and did a load of laundry. When he was 6 days old we drove 700 miles to my parent's house for Christmas and 3 weeks later I resumed my workouts. I know, most people would not do stuff like that, and it probably wasn't the smartest thing to do, but everything worked out fine. :)

>>the majority of things you get in your everyday life will get better with or without a doctor>>

Yes, but that's not good for business, and medicine is now a business. Someone has to pay all the insurance company and hospital/practice management group workers. That someone is the worried person with good insurance and a self-limiting minor problem who seeks medical attention.

Actually, GOOD physicians decrease the need for care, especially when they're exceptional educators.

It's not profitable to treat sick people who require medical attention. Sometimes really sick people hit lifetime insurance limits, or can't work and lose their insurance coverage altogether. That's especially bad for physicians, hospitals, and taxpayers, though it's good business for insurance companies.

In some states, when a child is kept home for illness or injuries, the school systems will not excuse the absence, even with a parent's note. The child will be held back after ten unexcused absences. So, even though my child is running a fever (which usually resolves itself within 24 hours), I am not qualified to reassure the school the I held my child home due to illness. Only a note from the doctor will get an absence excused.Why worry about unexcused absences? Homework and missed tests will NOT be allowed to be made up.Thus reinforcing the need to seek medical care for headaches, sore throats, ankle sprains, runny noses, and skinned knees. And treatments such as Sudafed and/or Tylenol and/or a band-aid requires a prescription from the doctor (okay, maybe not the band-aid) for doses that may be needed to keep the child in school for the session.

@remclave: That is utterly astonishing. I don't think I would agree to those rules. Do they honestly expect you to haul your actively vomiting child into an office? Most offices would tell you to stay the hell away.

Does your school system get some sort of kick-back from the insurance company? I'd be parking my ass at the next school board meeting and demand changes to this policy. I can't believe any medical professional would support such ridiculous garbage.

And, if my child required Tylenol to keep a fever down, they would NOT be going to school.

Remclave, I also believe that the days when schools trusted mere parents to be the guardians of their childrens' well-being are long past. Now the school is an arm of the state, part of government; the child is property of the state, a future parent and worker; and the parent gets to pay for all this while being treated as variously a crook, a nitwit or merely scum.

I think my son's school might have similar rules but they don't really enforce them. When he was in the hospital for a week, I just told them he was in the hospital and I kept everyone updated with daily blog posts. I never sent in a note from the doctor, they took my word for it. His school is great, though. After he was out of the hospital, but still doing the IV infusion thing an unable to attend school because of it (the IV infusion for 3 weeks was hell...every few hours, for 3 weeks...miserable, but life-saving), his teacher came to our house, on her own time, without getting paid any extra, to help make sure he was able to keep us with his class. He goes to a wonderful school, and it's a public school, too. People complain about public schools, but they can be good. :) They also let him out of school to participate in an 'educational trip'....we went to Disney. Hey, EPCOT is very educational. He just had to write a bit about what he learned during the trip and it was an excused absence.

Well, I do not run my kids to the doc-in-the-box with every sniffle or cough, but I do like the convenience of the nurse practitioner places (like the ones at Walgreens) when I suspect we might have strep throat. With 3 kids, we seem to have it at least 3 or 4 times a year and it's much easier than getting into the busy pediatrician's office or bothering the doc on call during the weekend. BTW, we have our pediatrician's blessing for these visits. I guess since he lives 3 doors down from us, he's glad I run the kids to Walgreens instead of ringing his doorbell.

"An advertisement in Britain for a cold relief capsule...would promise no more than that it might make you feel a bit better. You would still have a red nose and be in your dressing gown, but you would be smiling again, if wanly.

A commercial for the same product in America would guarantee total, instantaneous relief. An American who took this miracle compound would not only throw off his dressing gown and get back to work at once, he would feel better than he had for years and finish the day having the time of his life at a bowling alley."

Barb, you just reminded me of my next door neighbors. He's a city cop, she's an EMT. People run to them all the time. Hey, do you think I need stitches? What is this rash? That guy is driving way to fast down this street! I think that kid over there is selling pot!

My husband and I don't get people asking us about questions based on what we do because nobody can figure out what we do. I think we'll keep it that way. :-) Keep 'em guessing!

My boss seems to think that it's horribly abnormal to catch something...I work in an immunologist's office and when I had the flu/100+ degree fever this winter, I was practically eaten alive for "bailing" on my shift - one would think that the last place my diseased ass would need to be would be in an office surrounded by immuno-suppresed patients! I figured that of all places, doctor's office would be a little more understanding about the need for an occasional sick day!

My wife works at one of these places where the policy is no sick days without a doctors note. So, even when she obviously has the flu, she needs to either haul herself to work so she can smear germs around until they send her home, or haul herself to the doctors office and smear germs around until they sign off on her being sick enough.

My company's policy isn't much better, frankly; no sick days, just extra vacation days. So now you have an active disincentive to stay home when you are sick. Who wants to lay on the couch with tissue thinking about the summer camping trip they won't be taking when they could come to work and get all their coworkers sick instead? Once you find yourself in that situation the "You can't afford to be sick!" line starts to strike a chord.

My husband is anesthesiologist and emergency doc, so being ill as the normal neighbor doesnt get us any sympathies. "As long as you breathe independently, I'm not getting involved" he said with a grin when we met. He stayed true to his word (although I did get a wee bit sympathy when I had a nasty flu). We don't frequent the ER/docs more often than necessary, either. My parents only took us when we were seriously ill, and I think that's okay.

While we're all in the business of going on about what a virtue it is to eschew medical care, let me chime in: oh yeah, that childhood of untreated asthma was the way it's supposed to be. Parents who don't let their kids sit up all night wheezing and terrified are overprotective pansies. Hey, it's not like any American child would get off the couch to run around if she could breathe, amiright?

(OK, seriously, aside from being idiots about the asthma and sprains, I have very good parents.)

Whenever I see ads like this for urgent care, I don't think they're drawing in folks who wouldn't otherwise go to the doctor, they're drawing in folks who would *otherwise go to the ER*. Somehow I can't see an ad campaign that comes right out and says that being too successful.

I agree our society is way too dependant on medical care, especially drugs. After surgery the docs like to give laxatives to counter the constipating side effects of other meds like pain relievers. In the hospital they were constantly shoving colace at me and that stuff is just as bad as the problem it is used for. Haven't they ever heard of prune juice?

I've always subscribed to the belief that "it's nothing, it will go away." I am constantly getting yelled at (and occasionally admitted into a hospital) for this, because I'm a diabetic.

typical situation:me - "It's just a little wheezing and coughing. I wouldn't bother to come in but my fever went over 102."dr - "Actually you have pneumonia and I'm sending you to the hospital. By the way, how the hell are you upright?"

I'm pretty sure I'm gonna be one of those people who die from heart failure after "a little indigestion."

Oops, i also meant to comment on Old Med Girl's comment -- there's a good reason to send kids home for pink eye -- kids are notoriously awful about washing their paws (as my mum used to say) and pink eye can spread like wildfire. While I admit it's rarely complicated & goes away in a couple of days, there's no use having a room full of distracted, itchy-eyed kids.

Most people really do over use medical care, in my opinion BUTWhat can I say, I only take my son to the doctor when the problem has been present for quite a while without resolving or getting better. Last year's "little upset stomach" lasted so long that he was in tears when he begged up to take him to the doctor because he KNEW something was really wrong with him and he was scared...we trained him too well. He had been throwing up for months before he even told us about it. Turned out to be Acid Reflux.And then there is me who mistook a kidney infection for simple flu and treated it with rest and gatorade until it was really bad...

It's finding the balance that's difficult, as with so many things in life. There appears to be a section of society that looks for medical care at the smallest sign of a cold and another that ignores symptoms of life threatening severity assuming the condition will correct itself. If we could push everyone a little further into the middle, sensible, cohort all would be well.

Hey, Moose, my grandfather did that in 1976. He had indigestion, went to the kitchen to mix himself a 'bicarb' (baking soda and water, my father drinks a ton of that, and all I can say is YUCK!), and died of a heart attack within seconds.

Everyone in my family dies of cancer or a heart condition or Alzheimers. I'm going to try to go with the sudden heart attack that kills me in seconds while I'm riding a rollercoaster, after just having a lunch of corn dogs and french fries sometime after my 110th birthday.

Oh yeah, about the pink eye...yeah, stay home for that if you're a kid. It spreads easily between kids. Lice, too, for that matter. And strep throat? Strep throat is evil and we suspect that might have contributed to my son's meningitis. He had a small ear infection, a kid with strep decided to scream into his ear at close range, his spit laced with strep got into my son's ear and mingled with the ear infection, and a week later he was fighting for his life. Ack!

I can't stand places of employment that force their employees to go to work sick and spread it around. What a stupid policy.

I'm right there with you. I've been downright embarrassed some of the times I've taken my son to the doctor, but I wasn't taking any chances with his HLHS. As he's gotten older, I've gotten better at treating him like a "normal" kid, within reason.

There have been times that doctors have been guilty of this with us, though. Like the GI doc after my son had some bloody emesis last December. His scope was completely clean, we started Prevacid, and he hasn't had any episodes since. I suggested we stop follow-up appointments and I would call if he had any more problems, and they balked. Yet this is the same office that didn't bother to follow up when my son's INR came back > 16, AND they faxed the results to his pediatrician and cardiologist without a word of explanation. Writing about it makes me mad all over again. Maybe it's time to quietly bow away from that practice after all.

I feel weird even thinking about going to see a doctor for 'common illnesses' that only time will resolve.

In fact... if a cold/stomach bug/small 2nd degree burn were even documented or mentioned during a visit, it's because I happened to um, burn myself with an curling iron a day before a scheduled f/u appt for other chronic stuff.

I just had my super delayed f/u appt with my neuro-onc, who in turn is punishing me with bazillion scans(Yeah, 4hr MRI marathon). I tried using a PTO day for the appt which is a state over, so I couldn't come in part of the day. My HR changed it to a sick day... I'm so thankful how generous my company is. Though regardless of all this, if there's a deadline, I'll prob. drag myself in while sick unless someone chains to my bed.

Vag discharge may be icky, may be uncomfortable, but it is NOT urgent...despite what many patients may think. The likelihood of it seriously affecting your health in the next 2-3 days is as close to nil as possible.

I have three sons. They are active. Very active. So am/was I. For years we had someone w/ a broken bone or something torn or stitched.

I worked with a woman that was devastated when her 12 year old daughter broke her arm falling off a horse. She wouldn't let that child participate in P.E. for 18 months!! The girl was smart. She played Mom well.

At my house they were using their casted arms for bats 3 weeks after surgery.

She thought I was a terrible parent that minor injuries don't upset me. They are a part of raising kids as far as I am concerned.

Hey, Kim, my grandfather went in a similar fashion. Except he was a diabetic back in the days when all you could do is test your urine [by the time sugar gets to the urine damage is already being done]. Likely he had enough cardiac neuropathy that it masked the symptoms of a heart attack.

The REAL irony? He was head of cardiology for a major hospital in a big US city!

There are always people who think every sniffle requires priority triaging in the ER. They have been indoctrinated into thinking any illness is wrong and there should be a pill to fix it. You feel like shaking them and saying harden up princess and taking them up to the wards to see people who are really ill. Mind you for many that wouldn't change their mind (I say that as the psych that was often called in to chat with these people by frustrated ER staff).

Having been on both sides of the fence, worked in palliative care and neuro rehab and now have the joy of a progressive neuro/cardio disorder of my own, I've seen 'real' illness and must admit I have little tolerance for those who fall apart thanks to a sniffle. Plus as someone who spends a load of time getting tested and in docs offices I wonder why the hell anyone would want that. Doesn't help that I was brought up in a household where short of losing a limb there was no excuse for not attending school, work etc.

We forget how far medicine has come. A hundred years ago there were no treatments for MS. Myasthenia gravis was uniformly fatal within 5 years of diagnosis. There were no treatments for Parkinsons disease. The best available anticonvulsant was phenobarbital. There was no effective vascular surgery to reduce risk of stroke from carotid stenosis. The asylums were filled with neurosyphillis.

So of course people want treatment for minor ailments. They've come to expect miracles. Which is what medicine provides, sometimes.

okay I didn't read through the above comments because there's like a thousand, but forgive me for arguing against you here. this past summer I had a horrible ear infection. The pain was not improving so I called my doctor to make an appointment. they were completely booked and couldn't see me, so I instead went to one of those clinics inside a walgreens. it was a wonderful experience. the nurse practitioner was helpful and performed as thorough of an exam as she could. I received an antibiotic and went on my way. I believe the clinics are there for those type of cases. The ones where you just can't shake off that bug you've had for four-five days and you need something.

I don't think they're trying to create problems where there are none, I think they're just trying to provide a place of easy access to health care. you're going to have the people who abuse going to the doctor no matter where you go, so in this particular place it's just a little easier to get in to see someone. for the people who truly need it, it's a wonderful thing.

An urgent care I used to work for had a promotion right before deer season called "hunter physicals". It was basically a sports physical with an EKG and they were charging something like $75-100 for it (I'm sure no one's insurance was covering that). It was total BS. I think most of their target demographic thought so too, because the program didn't last very long.

Great post. Balance...LOL. You're asking the wrong person. I grew up with parents who never took me to the doctor unless the school made them, and it turns out I have two heart defects and a pacemaker. I'm probably lucky to be alive. Since I'm used to wheezing all the time, and I do get chest pain from it (and it's probably a problem swallowing due to my really rare heart defect), it's kind of hard to know when to go to the doctor. You know...what can be taken care of at home vs. what is an immediate problem.

When I was a kid I often got sent to school with a fever without tylenol. Ah, those were the days. Now if I start coughing I have to assume I will have bronchitis in about a day, so it's a bit different.

But I loved this post, especially since my coworkers don't seem to understand the chronic part of illness.

Jen: "The ones where you just can't shake off that bug you've had for four-five days and you need something."

This is the problem with antibiotic prescribing - you don't always need something for every little bug. If you have an ear infection, MAYBE. Before I get flack, read the actual guidelines for treatment (check out a Sanford) and remember, MOST cases of otitis media are caused by viruses. As are most "bugs". Say if you are 9 months old or ACTUALLY febrile (99 is warm for me, doc!) with OM (or have other circumstances), you do get abx, but every URI and every case of otitis does not deserves one.

Frankly, in this economy, I went to the doctor a lot more than I would have normally because my employer was psycho, and it was a CYA situation with getting a note. I didn't call in often, but every time I did, it was treated as if I were definitely sitting in a lawn chair sipping margaritas while naked men fed me grapes. Of course, when they wrote me out for two days with pink eye, I practically skipped out of the clinic. I can't say why it is for schoolkids, but people can't be too careful in certain jobs.

As a mother of three I am famous for saying "if you aren't bleeding, or an appendage dangling at an odd angle, I don't want to hear about it!"

There's definitely a difference between injuries, illness, and disease. Diseases need Dr. care - a tincture of time usually cures the other two unless severe.

@Kim - are we neighbors? My DH is police chief, I'm retired fire fighter/medic. We field all kinds of questions and I have no clue what my neighbors do! LOL

My BIGGEST beef with our country is with the entities that made the piss-poor decision allowing drug companies carte blanche advertisement space in magazines and then on television! Now it seems we have all these 'new' mental disorders, dysfunctions, twitching limbs preventing us from our deserved restful sleep, and can cure them all (rather conveniently) with a pill... oh, failed to mention, the pills don't CURE, they just MASK the symptoms (does that technically make one 'dependent'?)

Dr. Grumpy, imagine all the time you would save had this never occurred .... the position of wildly salivating rabid 'drug rep' didn't exist before this and you certainly wouldn't have to run away from them when you go out for tomatoes and diet coke!!?!?!?!

Well raised five sons, used to say " you will survive alot". When i was a kid, not long ago(smile) castor oil was my moms remedy for i swear everything. That and vicks, and spearmint water, and God knows what else she shoved down our throats. Now parents demand antibiotics for everything, and when you explain it is a virus, well you have no clue nursie do ya!!!No R.N. behind my name means absolutely registered nut, your right!!

I'm personally glad for urgent care, but as a physiologist, I know when it's appropriate to use them - like when I had (probable) strep. Would've been unwise to wait for an appointment at my regular practice (>1 week), and demoralizing (at the least) to attend the local ED.

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